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PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> 04-nr <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 4--44 -17 <br /> Permit#: PW17o4-Q44- <br /> PROJECT ADDRESS: 340 z-- 3 .th Dr LOT <br /> DESCRIPTION OF WORK:. SITE WORK FOR NEW TOWNHOME I TRAFFIC MITIGATION <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: POLYGON WLH LLC NAME: PNW Riverfront LLC <br /> ADDRESS: 11624 SE 5TH ST ADDRESS: 11624 SE 5th Street#200 <br /> BELLEVUE,WA,98005 BELLEVUE,WA, 98005 <br /> PHONE: PHONE: 4255867700 <br /> EMAIL: EMAIL: nicka@polygonhomes.com <br /> CONTACT: 0 Owner 0 Applicant ❑Other <br /> NAME: PANI ALAN <br /> PHONE: 4255867700 <br /> EMAIL: ALAN.PANI@POLYGONHOMES.COM <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required? YES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#:C /603-054-- <br /> FIRE <br /> 603—D5¢FIRE SPRINKLER REQUIRED?(by Fire Department/Code) <br /> 0 YES–Type (If yes,add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> ei<NO <br /> Explanation: <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: DJ FIRE SERVICE: <br /> %YES–Amount$ �,���' 3 0 YES–Amount$ <br /> 0 Meter Only, ❑Complete Service,Size ❑3/"Detect Meter Only, 0 Fire Service Size <br /> ❑ NO i'NO <br /> Explanation: Explanation: <br /> ❑ RPBA Needed at premise?-(Plumbing permit for backflow device needed due to High-Hazard Site per Tim Markham's review) <br /> ❑Water Department Cost Estimate Needed-(/f yes, PW Reviewer to send cost estimate request to Water Department, attach copy) <br /> Existing Utility Permit#(if applicable): <br /> SEWER FEE? DO <br /> EYES–Amount$ ---- *New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> 0 N <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? c 7 <br /> RYES–Amount: 5796 0 See Attached Spreadsheet aLL :uttdii Med,Y tel ,Stze <br /> El NO–No Change of Use/Other <br /> Explanation: <br /> (Note:Public Works Reviewer to Add Trafie Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> %YES–Amount$ 0 See Attached Spreadsheet <br /> ❑ NO - Per to;ke gry GiC P l.' a L <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> .9 YES–TYPE v^T'/', %See Attached Letter <br /> ❑ NO <br /> PW Reviewer: 9r116- Date: <br /> 4 -24 -17 <br /> REVISED 10/11/2016 <br />